{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:38:33Z","timestamp":1787755113661,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>A 15-year-old girl presented with significant right anterior knee pain and a varus-hyperextension gait pattern mimicking knee subluxation. Computed tomography (CT) revealed 44\u00b0 of femoral anteversion and 35\u00b0 of external tibial torsion. Magnetic resonance imaging and X-rays failed to demonstrate any abnormalities. Clinical examination supported by CT, EOS, and 3-dimensional gait analysis revealed axial malalignment. Femoral and tibial torsional osteotomies normalized gait, and clinical scores improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case highlights how torsional malalignment can produce dynamic sagittal and coronal gait dysfunction. Rotational correction resolved symptoms, emphasizing the need to include torsion assessment in patients with unexplained knee pain and gait dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.25.00407","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T19:01:15Z","timestamp":1770318075000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Lower Extremity Torsional Deformity as an Overlooked Cause of Gait Dysfunction"],"prefix":"10.2106","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2266-4630","authenticated-orcid":false,"given":"Nour","family":"Kabbes","sequence":"first","affiliation":[{"name":"McGill Faculty of Medicine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1311-1622","authenticated-orcid":false,"given":"Sepehr","family":"Mehrpouyan","sequence":"additional","affiliation":[{"name":"McGill Faculty of Medicine, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9523-0340","authenticated-orcid":false,"given":"Justin","family":"Drager","sequence":"additional","affiliation":[{"name":"Division of Orthopaedics, Departments of Surgery & Pediatric Surgery, McGill University Health Centre, Shriners Hospitals for Children\u2014Canada, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8678-1746","authenticated-orcid":false,"given":"Marianne","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Surgical and Interventional Sciences, Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada"},{"name":"Motion Analysis Center, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9336-0918","authenticated-orcid":false,"given":"Mitchell","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Division of Orthopaedics, Departments of Surgery & Pediatric Surgery, McGill University Health Centre, Shriners Hospitals for Children\u2014Canada, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7672-8477","authenticated-orcid":false,"given":"Louis-Nicolas","family":"Veilleux","sequence":"additional","affiliation":[{"name":"Division of Orthopaedics, Departments of Surgery & Pediatric Surgery, McGill University Health Centre, Shriners Hospitals for Children\u2014Canada, Montreal, Quebec, Canada"},{"name":"Motion Analysis Center, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1]]},"reference":[{"issue":"3","key":"bib1-20260205","first-page":"e23.00009","article-title":"Systematic literature review and meta-analysis on miserable malalignment syndrome","volume":"11","author":"Atallah","year":"2023","journal-title":"JBJS J Orthop Physician Assist."},{"issue":"1","key":"bib2-20260205","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s42399-023-01449-5","article-title":"Breaking Down torsional malalignment syndrome","volume":"5","author":"Holbert","year":"2023","journal-title":"SN Compr Clin Med."},{"issue":"4","key":"bib3-20260205","doi-asserted-by":"crossref","first-page":"343","DOI":"10.2106\/JBJS.18.01115","article-title":"Measuring lower extremity rotational alignment: a review of methods and case studies of clinical applications","volume":"102","author":"Shih","year":"2020","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib4-20260205","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/01241398-200407000-00009","article-title":"Surgical correction of miserable malalignment syndrome","volume":"24","author":"Bruce","year":"2004","journal-title":"J Pediatr Orthop."},{"key":"bib5-20260205","doi-asserted-by":"crossref","first-page":"e568","DOI":"10.1097\/BPO.0000000000002939","article-title":"Presurgery and postsurgery outcomes following lower extremity torsional osteotomies","volume":"45","author":"Gagnon","year":"2025","journal-title":"J Pediatr Orthop."},{"issue":"10","key":"bib6-20260205","doi-asserted-by":"crossref","first-page":"e0291458","DOI":"10.1371\/journal.pone.0291458","article-title":"Influence of femoral anteversion angle and neck-shaft angle on muscle forces and joint loading during walking","volume":"18","author":"Kainz","year":"2023","journal-title":"PLoS One."},{"issue":"11","key":"bib7-20260205","doi-asserted-by":"crossref","first-page":"686","DOI":"10.2519\/jospt.2003.33.11.686","article-title":"The influence of tibial and femoral rotation on patellofemoral contact area and pressure","volume":"33","author":"Lee","year":"2003","journal-title":"J Orthop Sports Phys Ther."},{"issue":"1","key":"bib8-20260205","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11751-013-0181-8","article-title":"Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability","volume":"9","author":"Stevens","year":"2014","journal-title":"Strateg Trauma Limb Reconstr."},{"issue":"1","key":"bib9-20260205","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1186\/s13018-023-04252-z","article-title":"Miserable malalignment syndrome associated knee pain: a case for infra-tubercle tibial de-rotation osteotomy using an external fixator","volume":"18","author":"Elsheikh","year":"2023","journal-title":"J Orthop Surg Res."},{"issue":"2","key":"bib10-20260205","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s10195-013-0260-0","article-title":"Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up","volume":"15","author":"Leonardi","year":"2014","journal-title":"J Orthop Traumatol."},{"issue":"12","key":"bib11-20260205","doi-asserted-by":"crossref","first-page":"3530","DOI":"10.3390\/jcm11123530","article-title":"Torsional abnormality: the forgotten issue in the diagnosis and treatment of the anterior knee pain patient","volume":"11","author":"Sanchis-Alfonso","year":"2022","journal-title":"J Clin Med."},{"issue":"3","key":"bib12-20260205","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.gaitpost.2010.06.019","article-title":"Torsional profile versus gait analysis: consistency between the anatomic torsion and the resulting gait pattern in patients with rotational malalignment of the lower extremity","volume":"32","author":"Radler","year":"2010","journal-title":"Gait Posture."},{"issue":"8","key":"bib14-20260205","doi-asserted-by":"crossref","first-page":"2325967120944113","DOI":"10.1177\/2325967120944113","article-title":"Treatment for symptomatic genu recurvatum: a systematic review","volume":"8","author":"Dean","year":"2020","journal-title":"Orthop J Sports Med."},{"issue":"4","key":"bib15-20260205","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/01241398-199607000-00012","article-title":"Treatment of severe torsional malalignment syndrome","volume":"16","author":"Delgado","year":"1996","journal-title":"J Pediatr Orthop."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.25.00407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:37:42Z","timestamp":1787751462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.25.00407"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.25.00407","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}